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Clinical Outcomes and Prognosis Markers of Patients With Liver Disease Undergoing Transcatheter Aortic Valve Replacement

2018; Lippincott Williams & Wilkins; Volume: 11; Issue: 3 Linguagem: Inglês

10.1161/circinterventions.117.005727

1941-7632

Gabriela Tirado‐Conte, Josep Rodés‐Cabau, Ramón Rodríguez‐Olivares, Marco Barbanti, Thibault Lhermusier, Ignacio J. Amat‐Santos, Stefan Toggweiler, Asim N. Cheema, Antonio J. Muñoz-García, Violeta Serra, Francesca Giordana, Gabriela Veiga Fernández, Pilar Jiménez‐Quevedo, Francisco Campelo‐Parada, Lucca Loretz, Denise Todaro, María Del Trigo, José M. Hernández-García, Bruno García del Blanco, Francesco Bruno, José M. de la Torre Hernández, Pieter R. Stella, Corrado Tamburino, Carlos Macaya, Luis Nombela‐Franco,

Cardiovascular Function and Risk Factors

Background— Chronic liver disease is a known risk factor for perioperative morbidity and mortality in patients undergoing cardiac surgery. Very little data exist about such patients treated with transcatheter aortic valve replacement (TAVR). Our objective was to evaluate early and late clinical outcomes in a large cohort of patients with liver disease undergoing TAVR and to determine predictive factors of mortality among these patients. Methods and Results— This multicenter study collected data from 114 patients with chronic liver disease who underwent TAVR in 12 institutions. Perioperative and long-term outcomes were compared with a cohort of 1118 patients without liver disease after a propensity score–matching analysis (114 matched pairs). In-hospital mortality and vascular and bleeding complications were similar between matched groups. Acute kidney injury was more common in liver disease group (30.8% versus 13.5%; P =0.010). Although cardiovascular mortality was similar between groups (9.4% versus 6.5%; P =0.433) at 2-year follow-up, noncardiac mortality was higher in the liver group (26.4% versus 14.8%; P =0.034). Lower glomerular filtration rate (hazard ratio, 1.10, for each decrease of 5 mL/min in estimated glomerular filtration rate; 95% confidence interval, 1.03–1.17; P =0.005) and Child-Pugh class B or C (hazard ratio, 3.11; 95% confidence interval, 1.47–6.56; P =0.003) were the predictors of mortality in patients with chronic liver disease, with a mortality rate of 83.2% at 2-year follow-up in patients with both factors (estimated glomerular filtration rate <60 mL/min and Child-Pugh B or C). Conclusions— These findings suggested that TAVR is a feasible treatment for severe aortic stenosis in patients with early-stage liver disease or as bridge therapy before a curative treatment of the hepatic condition. Patients with Child-Pugh class B-C, especially in combination with renal impairment, had a very low survival rate, and TAVR should be carefully considered to avoid a futile treatment. These results may contribute to improve the clinical decision-making process and management in patients with liver disease.